Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes

J. A. Stokes, M. S. Roberts, Michelle Annette King, T. A. Lynne, D. M. Purdie, P. P. Glasziou, A. J. Wilson, S. T. McCarthy

    Research output: Contribution to journalArticle

    159 Citations (Scopus)

    Abstract

    Aims To evaluate whether year long clinical pharmacy program involving development of professional relationships, nurse education on medication issues, and individualized medication reviews could change drug use, mortality and morbidity in nursing home residents.

    Methods A cluster randomised controlled trial, where an intervention home was matched to three control homes, was used to examine the effect of the clinical pharmacy intervention on resident outcomes. The study involved 905 residents in 13 intervention nursing homes and 2325 residents in 39, control nursing homes in southeast Queensland and north-east New South Wales, Australia. The outcome measures were. continuous drug use data from government prescription subsidy claims, cross-sectional drug use data on prescribed and administered medications, deaths and morbidity indices (hospitalization rates, adverse events and disability indices).

    Results This intervention resulted in a reduction in drug use with no change in morbidity indices or survival. Differences in nursing home characteristics as defined by cluster analysis with SUDAAN(R). negated intervention-related apparent significant improvements in survival. The use of benzodiazepines, nonsteroidal anti-inflammatory drugs. laxatives, histamine H-2-receptor antagonists and antacids was significantly reduced in the intervention group, whereas the use of digoxin and diuretics remained similar to controls. Overall, drug use in the intervention group was reduced by 14.8%, relative to the controls, equivalent to an annual prescription saving of $A64 per resident (approximately pound 25).

    Conclusions This intervention improved nursing home resident outcomes related to changes in drug use and drug-related expenditure. The continuing divergence in both drug use and survival at the end of the study suggests that the difference would have been more significant in a larger and longer study, and even more so using additional instruments specific for measuring outcomes related to changes in drug use.

    Original languageEnglish
    Pages (from-to)257-265
    Number of pages8
    JournalBritish Journal of Clinical Pharmacology
    Volume51
    DOIs
    Publication statusPublished - 2001

    Keywords

    • aged
    • clinical pharmacy services
    • cost effectiveness
    • drug utilization
    • education
    • long-term care
    • nursing homes
    • patient care team
    • patient outcome
    • DRUG-USE
    • FALLS

    Cite this

    Stokes, J. A., Roberts, M. S., King, M. A., Lynne, T. A., Purdie, D. M., Glasziou, P. P., ... McCarthy, S. T. (2001). Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. British Journal of Clinical Pharmacology, 51, 257-265. https://doi.org/10.1046/j.1365-2125.2001.00347.x

    Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. / Stokes, J. A.; Roberts, M. S.; King, Michelle Annette; Lynne, T. A.; Purdie, D. M.; Glasziou, P. P.; Wilson, A. J.; McCarthy, S. T.

    In: British Journal of Clinical Pharmacology, Vol. 51, 2001, p. 257-265.

    Research output: Contribution to journalArticle

    Stokes, JA, Roberts, MS, King, MA, Lynne, TA, Purdie, DM, Glasziou, PP, Wilson, AJ & McCarthy, ST 2001, 'Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes', British Journal of Clinical Pharmacology, vol. 51, pp. 257-265. https://doi.org/10.1046/j.1365-2125.2001.00347.x
    Stokes, J. A. ; Roberts, M. S. ; King, Michelle Annette ; Lynne, T. A. ; Purdie, D. M. ; Glasziou, P. P. ; Wilson, A. J. ; McCarthy, S. T. / Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. In: British Journal of Clinical Pharmacology. 2001 ; Vol. 51. pp. 257-265.
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    abstract = "Aims To evaluate whether year long clinical pharmacy program involving development of professional relationships, nurse education on medication issues, and individualized medication reviews could change drug use, mortality and morbidity in nursing home residents.Methods A cluster randomised controlled trial, where an intervention home was matched to three control homes, was used to examine the effect of the clinical pharmacy intervention on resident outcomes. The study involved 905 residents in 13 intervention nursing homes and 2325 residents in 39, control nursing homes in southeast Queensland and north-east New South Wales, Australia. The outcome measures were. continuous drug use data from government prescription subsidy claims, cross-sectional drug use data on prescribed and administered medications, deaths and morbidity indices (hospitalization rates, adverse events and disability indices).Results This intervention resulted in a reduction in drug use with no change in morbidity indices or survival. Differences in nursing home characteristics as defined by cluster analysis with SUDAAN(R). negated intervention-related apparent significant improvements in survival. The use of benzodiazepines, nonsteroidal anti-inflammatory drugs. laxatives, histamine H-2-receptor antagonists and antacids was significantly reduced in the intervention group, whereas the use of digoxin and diuretics remained similar to controls. Overall, drug use in the intervention group was reduced by 14.8{\%}, relative to the controls, equivalent to an annual prescription saving of $A64 per resident (approximately pound 25).Conclusions This intervention improved nursing home resident outcomes related to changes in drug use and drug-related expenditure. The continuing divergence in both drug use and survival at the end of the study suggests that the difference would have been more significant in a larger and longer study, and even more so using additional instruments specific for measuring outcomes related to changes in drug use.",
    keywords = "aged, clinical pharmacy services, cost effectiveness, drug utilization, education, long-term care, nursing homes, patient care team, patient outcome, DRUG-USE, FALLS",
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    T1 - Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes

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    AU - Roberts, M. S.

    AU - King, Michelle Annette

    AU - Lynne, T. A.

    AU - Purdie, D. M.

    AU - Glasziou, P. P.

    AU - Wilson, A. J.

    AU - McCarthy, S. T.

    PY - 2001

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    N2 - Aims To evaluate whether year long clinical pharmacy program involving development of professional relationships, nurse education on medication issues, and individualized medication reviews could change drug use, mortality and morbidity in nursing home residents.Methods A cluster randomised controlled trial, where an intervention home was matched to three control homes, was used to examine the effect of the clinical pharmacy intervention on resident outcomes. The study involved 905 residents in 13 intervention nursing homes and 2325 residents in 39, control nursing homes in southeast Queensland and north-east New South Wales, Australia. The outcome measures were. continuous drug use data from government prescription subsidy claims, cross-sectional drug use data on prescribed and administered medications, deaths and morbidity indices (hospitalization rates, adverse events and disability indices).Results This intervention resulted in a reduction in drug use with no change in morbidity indices or survival. Differences in nursing home characteristics as defined by cluster analysis with SUDAAN(R). negated intervention-related apparent significant improvements in survival. The use of benzodiazepines, nonsteroidal anti-inflammatory drugs. laxatives, histamine H-2-receptor antagonists and antacids was significantly reduced in the intervention group, whereas the use of digoxin and diuretics remained similar to controls. Overall, drug use in the intervention group was reduced by 14.8%, relative to the controls, equivalent to an annual prescription saving of $A64 per resident (approximately pound 25).Conclusions This intervention improved nursing home resident outcomes related to changes in drug use and drug-related expenditure. The continuing divergence in both drug use and survival at the end of the study suggests that the difference would have been more significant in a larger and longer study, and even more so using additional instruments specific for measuring outcomes related to changes in drug use.

    AB - Aims To evaluate whether year long clinical pharmacy program involving development of professional relationships, nurse education on medication issues, and individualized medication reviews could change drug use, mortality and morbidity in nursing home residents.Methods A cluster randomised controlled trial, where an intervention home was matched to three control homes, was used to examine the effect of the clinical pharmacy intervention on resident outcomes. The study involved 905 residents in 13 intervention nursing homes and 2325 residents in 39, control nursing homes in southeast Queensland and north-east New South Wales, Australia. The outcome measures were. continuous drug use data from government prescription subsidy claims, cross-sectional drug use data on prescribed and administered medications, deaths and morbidity indices (hospitalization rates, adverse events and disability indices).Results This intervention resulted in a reduction in drug use with no change in morbidity indices or survival. Differences in nursing home characteristics as defined by cluster analysis with SUDAAN(R). negated intervention-related apparent significant improvements in survival. The use of benzodiazepines, nonsteroidal anti-inflammatory drugs. laxatives, histamine H-2-receptor antagonists and antacids was significantly reduced in the intervention group, whereas the use of digoxin and diuretics remained similar to controls. Overall, drug use in the intervention group was reduced by 14.8%, relative to the controls, equivalent to an annual prescription saving of $A64 per resident (approximately pound 25).Conclusions This intervention improved nursing home resident outcomes related to changes in drug use and drug-related expenditure. The continuing divergence in both drug use and survival at the end of the study suggests that the difference would have been more significant in a larger and longer study, and even more so using additional instruments specific for measuring outcomes related to changes in drug use.

    KW - aged

    KW - clinical pharmacy services

    KW - cost effectiveness

    KW - drug utilization

    KW - education

    KW - long-term care

    KW - nursing homes

    KW - patient care team

    KW - patient outcome

    KW - DRUG-USE

    KW - FALLS

    U2 - 10.1046/j.1365-2125.2001.00347.x

    DO - 10.1046/j.1365-2125.2001.00347.x

    M3 - Article

    VL - 51

    SP - 257

    EP - 265

    JO - British Journal of Clinical Pharmacology

    JF - British Journal of Clinical Pharmacology

    SN - 0306-5251

    ER -